I Had Lower Eyelid Skin Removed and a Face Lift. My Lower Lid is Drooping, What Can I Do? Is It Permanent? (photo)

On 11-29-11 I had lower bleph with skin removed and fat pockets removed. I also had a face lift. My right lower eyelid is now drooping and has a broken blood vessel. at the 2 week point the doctor gave me cortisone shots today. I am 56 yrs old and did not have any issues with my lids prior. I am massaging but am not seeing much improvement at the 2 wk post operative time frame. Should I be worried, what should I do? I am afraid this is permanent? Please help.

Doctor Answers 8

Post-blepharoplasty ectropion

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I agree that your photos do demonstrate an ectropion and that you should not rush into revisional surgery.  You are still in the initial postop period and the wound needs to settle down before any re-operation.  The situation may resolve in part.  Also, operating too soon, in a healing wound, carries its own risks because the tissues are still swollen, as demonstrated by your photographs.  Conservative management and watchful waiting would be key here.  Please continue to followup with your plastic surgeon and to discuss a plan going forward.

Eye issue after facelift and eyes

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Commonly after blepharoplasty, especially if a skinmuscle flap was elevated from a lower lidi incision, the muscle fucntion is temporarily weakened. In patients with poor loewr lid tone before surgery and what is called a negative  vector ( the cheek bone is not prominent to begin with), then often  canthopexy is peformed to support the lower lid.  Some patients get an early ectropion post-op and I would not ruch for furtehr surgery withmy patients. I usually recommend massage and/or taping, and good eye lubrication. This often gets better over the first 4-6 weeks. But even if it doesn't, I would wait to reoperate.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Lower eyelid drooping after eyelid surgery. What should you do?

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Normally, I wouldn't answer this question as you have already received the appropriate advice from two doctors.  But I will add my voice to counteract the dissenting opinion.  IMHO, the advice you received to reoperate now, before scar tissue sets in is absolutely wrong.  You are still significantly swollen and bruised and it takes time to heal.  I agree with the last responder who stated that early intervention, however well meaning, may complicate your proble,  Take a deep breath, relax, and wait 6 months if you truly want to get the best possible outcome.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.8 out of 5 stars 140 reviews

I would not be in a rush to judge how this will turn out.

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You are very early from surgery.  I agree that you look like you have an issue.  The important thing at this moment is finger winking the lower eyelid to help it from healing in a compromised position.  WIll you need revisional surgery to address this?  It is honestly too early to tell.  Sometimes, well meaning early interventions just make things worse not better.  I would strongly encourage you and your surgeon to stick with conservative measures for the time being.  What you look like today will improve and be much less severe with appropriate management.  Unless there is pressing clinical concerns, revisional surgery if even necessary should wait until 6 to 12 months from now.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lower lid drooping after blepharoplasty

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Its only been 2 weeks. I would encourage you to closely follow with your surgeon, continue massaging as instructed and you may ask your surgeon if he or she feels there would be a benefit in taping the lower lid for support. I would be careful with cortisone injections in the lower lid as this may cause additional lipoatrophy and hollowing. It will take 3-6 months to see the final results and determine if you need additional procedure for correction of residual ectropion. In the mean time, keep your eye well moisturized to avoid drying and corneal abrasion using artificial tears.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon

Repair of a ectropion

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You do have an ectropion which more than likely was due to some pre-existing laxity of the lower lid.  This can be repaired by a cantholysis and lower lateral canthal tendon tightening / canthopexy.  If it does not resolve by the 6 month time frame  a repair may be needed to avoid corneal exposure problems.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Early Ectropion

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This is a known complication of lower lid blepharoplasty performed through a subciliary approach. It is still early in the recovery. Most early ectropion completely resolves with active massage. To help lubricate the globe during sleep, use taping or your surgeon can place a tarsorrhaphy suture. While awake, use lubricating drops.

You need revision sooner than later

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Your lower lid has scarred down to the orbital rim and pulling on your lid. Please try to push up on your lower lid and if you see the tissue moves up and not stuck to the bone, then you have lax lower lid and will need canthoplasty. If the lower lid tissue stuck down,then you will need release of scar tissue and canthoplasty.  The problem with waiting is the conjunctivitis ,dry eye and scar tissue buildup.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.